PubMed · 8418390
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C J Okstein. Computer-generated discharge instruction sheets.. https://pubmed.ncbi.nlm.nih.gov/8418390/
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BACKGROUND: The burden of cancer mortality falls disproportionately on cancer patients belonging to ethnic minority groups. In the U.S., African American, Hispanic, and American Indian cancer patients are diagnosed at a more advanced stage and receive less appropriate treatment, resulting in poorer outcomes and higher mortality, than white cancer patients. The authors hypothesized that cancer control strategies based on earlier detection and more effective treatment may be most effective in increasing survival in groups with more advanced disease at diagnosis, less appropriate treatment, and lower survival. METHODS: Data collected by the New Mexico Tumor Registry, a member organization of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, afforded the authors an opportunity to investigate this hypothesis by studying trends in cancer survival for American Indians, Hispanics, and non-Hispanic whites. The authors examined temporal trends and ethnic disparities in survival for in situ and invasive incident cancer cases at 25 sites diagnosed from 1969 through 1994 in New Mexico residents and in American Indians residing in Arizona. RESULTS: The distribution of stage became more favorable and the percentage of patients receiving appropriate treatment increased for all three ethnic groups during the study period. Survival improved for patients with cancer at most sites in each ethnic group; however, because the increase in survival was greater for non-Hispanic whites than for American Indians or Hispanics, the number of sites associated with disparities in survival among non-Hispanic whites, American Indians, and Hispanics increased. Differences in the distribution of age, gender, stage at diagnosis, histologic grade, and treatment did not completely explain the improved survival or the ethnic disparities regarding survival. CONCLUSIONS: Increased cancer control efforts were associated with earlier diagnosis, more patients receiving appropriate therapy, and improved survival for non-Hispanic whites, American Indians, and Hispanics. However, the improvement was greatest for non-Hispanic whites, and disparities in survival results for the different ethnic groups widened over the period of study. Cancer control strategies need to address the specific social, cultural, and biologic prognostic factors that affect different ethnic groups if disparities in outcomes are to be reduced.
A case of an isolated subcutaneous coccidioidomycosis in a 61-year-old man is presented. The patient has lived and worked in Arizona for 3 years previously but developed no apparent clinical signs of the disease. The painless, cavitating, tumor-like mass was surgically excised and the diagnosis was established by histological demonstration of the fungi and confirmed by serum counterimmunoelectrophoresis. This represents the first imported case of coccidioidomycosis in Hungary.
In the third National Health and Nutrition Examination Survey (NHANES III) conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, radiographs of the hands and knees were taken of participants 60 years and older as part of the study of arthritis and musculoskeletal conditions. The purpose of the study was to decide the digitizing resolution to be used for these radiographs. A set of wrist and hand radiographs (N = 49) was graded by two radiologists for degree of bone erosions and served as a "gold standard." The radiographs were then digitized at three resolution levels; low-resolution 150 microns (2001 x 1634 x 12 bit matrix); intermediate-resolution 100 microns (3000 x 2400 x 12 bit matrix); and high-resolution 50 microns (4900 x 3000 x 12 bit matrix). A comparison of the digital images versus the gold standard reading was made at the three resolutions by two radiologists. Kappa statistics suggested fair (K > .4) to excellent (K > .75) agreement between the gold standard and the images at all levels. Intraclass correlation coefficient suggested high agreement between readers (ICC > .5), with minimal individual reader effect. Variance component estimates showed that the major contribution (78-83%) to scoring came from variability in the images themselves, not from the readers. The 100 microns resolution was selected over the 150 and 50 microns on the basis of practical considerations such as storage requirements, display time, and easier manipulation of the digital images by the readers.